Clinical Practice Guidelines Antenatal Care — Module II
Providing woman-centred care
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- Improving women’s experience of antenatal care
- Multicultural health workers
- Providing information and support so that women can make decisions
- Interpreters
2.2Providing woman-centred care“Establishing effective communication between a woman and her midwife [or other health professional] is essential for determining how culturally safe care can be instituted.” (Carolan & Cassar 2008) The fundamentals of providing care discussed in Chapter 1 apply to all women. This section discusses issues specific to providing appropriate antenatal care for migrant and refugee women. Improving women’s experience of antenatal careTaking an individualised approachFactors that may improve the experience of antenatal care for migrant and refugee women include: taking the time to establish rapport and trust with each woman; being conscious of the need to avoid making assumptions based on a woman's culture, ethnic origin or religious beliefs; explaining the woman’s entitlement to antenatal care and options for accessing it (eg community clinic or hospital-based setting); considering issues that may influence attendance at appointments, such as transport, cost considerations (access to Medicare rebates, need to attend a service that offers bulk billing, cost of procedures such as ultrasounds); considering a woman’s support network (eg support from partner, family and friends, and family dynamics); consulting the woman about whom she would like to involve in her care and, if necessary, advocating on her behalf so that she receives appropriate care throughout pregnancy; respectfully exploring cultural and personal understanding and experience of pregnancy and appropriate self-care in pregnancy, and encouraging the woman to discuss anything she is worried or unsure about; explaining frequently used terms that the woman is likely to hear at antenatal appointments with different health professionals; explaining confidentiality and that the woman’s privacy will be respected; and checking the woman’s understanding of what has been discussed.
The care needs of migrant and refugee women can be complex. The first point of contact (eg first antenatal visit) is important and care should be undertaken with an accredited health interpreter. Wherever possible, antenatal care should involve a multicultural health worker. Multicultural health workersIn many states and territories, roles such as multicultural health workers have been developed. Multicultural health workers (also known as bicultural health workers) assist people from migrant and refugee communities to access health services. For example, a multicultural health worker might support a woman to attend antenatal appointments by booking or confirming appointments, helping to fill out forms and questionnaires, assisting with transport and finding clinic locations. They may also provide services that are appropriate to women’s culture and language, such as referral, group work, health education and community development. While the multicultural health worker may communicate with the woman in her preferred language, the role differs from that of an interpreter in that a wider range of services is provided, and a continuing relationship is generally formed between the health worker and the woman and her family. While there is little evidence specific to antenatal care, a systematic review of the literature on culturally appropriate interventions to manage or prevent chronic disease in migrant and refugee communities found that the use of multicultural health workers can promote greater uptake of disease prevention strategies by migrant and refugee communities and also translate into greater knowledge and awareness about services (Henderson et al 2011). Providing information and support so that women can make decisionsIt may be necessary to use a variety of means to communicate effectively with women from migrant and refugee backgrounds. Information should be explained carefully and clearly, with the assistance of an accredited health interpreter. Some words cannot be interpreted easily, and the health professional may need to explain the concept or give examples. It is important to agree on a set of terms that are mutually understood and if necessary use pictures. For example, using charts and models to demonstrate particular body parts can reduce misinterpretation. Acronyms and abbreviations should be avoided, as these can be confusing. Written information should also be provided; this can serve as a prompt or can be shown to other health professionals who can then remind the woman or explain the information again. Literacy levels in the woman’s own language should not be assumed. Video or audio resources may also be appropriate.
Interpreters accredited by NAATI (National Association of Accreditation for Translators and Interpreters) have been assessed as having a high level of technical competence in both English and one or more other languages and are bound by a code of ethics including strict confidentiality. However, there is a shortage of accredited interpreters, particularly for languages of new and emerging communities. While involvement of female interpreters is preferable in antenatal care, their availability may also be limited. Non-accredited interpreters, including partners, family and friends, should not be used as they are less able to convey complex medical information in an accurate and non-emotive way. Their involvement may also discourage the woman from disclosing information fully, out of embarrassment or fear of breach of confidentiality. In emergency situations where the timing of decision-making is crucial, it may be necessary for non-accredited interpreters to assist with communication but it is not appropriate to involve people younger than 18 years of age in this role. Staff members who speak the relevant language may provide language assistance but should not be asked to act as interpreters. Organisational policy should be followed at all times and an accredited interpreter (in person or through a telephone service) sought as quickly as possible. The decision to involve a non-accredited interpreter should be documented in the woman’s antenatal record. Women may not request an interpreter as they believe there is a cost involved or be unaware that such a service exists. Women may also be sensitive about their level of English proficiency and may have concerns about confidentiality. However, it is important that the onus for using an interpreter is not on the woman. Practice point b Health professionals should take the initiative in organising for an accredited health interpreter wherever necessary, and reassure the woman of the benefits if she is reluctant. The use of interpreters can be promoted by (CEH 2009): having translated information in community languages in the reception area, stating that accredited interpreters are available and free of charge; advising individual women verbally that interpreters are available and free of charge; and including information about the code of ethics of accredited interpreters regarding confidentiality, accuracy and the procedure for working with interpreters. Table 2 : Involving an interpreter
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